Healthcare Provider Details

I. General information

NPI: 1326043258
Provider Name (Legal Business Name): MARK STEVEN CUKIERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 02/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7445 FENWICK PL
BOCA RATON FL
33496-1308
US

IV. Provider business mailing address

7445 FENWICK PL
BOCA RATON FL
33496-1308
US

V. Phone/Fax

Practice location:
  • Phone: 917-697-9883
  • Fax:
Mailing address:
  • Phone: 917-697-9883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA50376
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number167745
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME82479
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: